Abstract
BackgroundSymptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.MethodsIndividual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001–2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000–2013) based on International Classification of Disease (ICD-10) code.ResultsOf the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04–1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12–3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002).ConclusionsPatients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.
Highlights
Symptomatic pulmonary embolism (PE) is the third largest cause of cardiovascular death after coronary artery disease and stroke, occurring in about 100 persons per 100,000 annually [1,2]
Of the 1,142 patients included in this study, 935 (81.9%) had no atrial fibrillation (AF) during index PE admission whilst 207 patients had documented baseline AF
Independent predictors for subsequent AF after acute PE include age, history of congestive cardiac failure (HR 1.88, 95% CI 1.12– 3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002)
Summary
Symptomatic PE is the third largest cause of cardiovascular death after coronary artery disease and stroke, occurring in about 100 persons per 100,000 annually [1,2]. The mechanism of stroke is understood to be thrombus formation in the fibrillating left atrium or atrial appendage, with subsequent embolization. Yasuoka et al noted right atrial spontaneous echo-contrast in patients with nonvalvular AF and concluded that it may be a predictive factor for PE. The worldwide prevalence and incidence of AF in developed countries are estimated at 388–661 per 100,000, and 90–123 per 100,000 person-years respectively [9,10,11]. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. The prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.
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